Exam 2 Flashcards
Following an appointment with the primary care provider, the nurse is teaching an independent living older adult about a newly prescribed medication. Which factor is most likely to interfere with the effectiveness of this process?
1. The patient wears a hearing aid.
2. The patient has a history of hypothyroidism.
3. The nurse provided written handouts.
4. The nurse is in a hurry.
Correct answer: 4
Older adults and their families or significant others should be given complete information about the prescribed medications and the proper method for taking them. If possible, nurses should select a time when the older adult’s anxiety level is low, because the individual will be more likely to remember the important points when calm. If the directions are complex, extra time may be necessary to ensure that they are understood completely. Commonly, older persons fail to ask questions because they are afraid of being judged as ignorant or bothersome. If the nurse seems hurried, the older person may not feel comfortable asking necessary questions.
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What is an example of a medication that can be crushed?
1. A potassium tablet
2. Enteric-coated aspirin
3. Sublingual nitroglycerin
4. A calcium tablet
Correct answer: 4
If a liquid form of medication is not available, the tablet or capsule may have to be crushed or broken to facilitate swallowing. Not all medications can be crushed or broken because these activities can alter the action of the drug. A calcium tablet may be crushed. Sustained-release capsules, enteric-coated aspirin, and sublingual nitroglycerine are examples of medications that should not be crushed or chewed.
You are administering medication through a transdermal patch, What are some precautions?
(Select all that apply.)
1. Remove all old patches before applying a new patch.
2. Use the same location each time for consistent absorption.
3. Cleanse the skin after removing an old patch.
4. Dispose old patches in the toilet.
5. Verify the dosage strength of the patch.
6. Wear gloves.
7. Tape over the patch to keep it secure.
Correct answers: 1, 3, 5, 6
Precautions when using transdermal patches include removal of all old patches and cleansing of the skin before applying a new one, verification of the dosage strength of the patch, and handling the patch so that the skin does not come in contact with the medicated portion wearing gloves is recommended to avoid touching the medicated surface). Tape should never be used to secure a patch.
A resident in a long-term care facility has an order for digoxin (Lanoxin) 0.25 mg every morning in tablet form. If the nurse assesses that this resident has been having difficulty swallowing, what should the nurse do?
1. Administer the digoxin (Lanoxin) in liquid form.
2. Crush the digoxin (Lanoxin) for administration.
3. Withhold the digoxin (Lanoxin) and document.
4. Discuss the possibility of an order change to liquid form with the primary care provider.
Correct answer: 4
Problems arise when the older person is unable to swallow tablets. Because liquids might be absorbed more rapidly than solids, all changes in medication form require a physician’s order.
Why are older adults more likely to experience adverse drug reactions?
1. Because of the number of medications they take daily
2. Because of physiologic changes in metabolism and excretion
3. Because of higher percentage of body fluid
4. Because of cognitive changes
5. Because of interactions with foods, OTC preparations, and herbal supplements
6. Because of decreased sense of taste
Correct answers: 1, 2, 4
Factors that increase the risk for medication-related problems in older adults include use of multiple medications, herbal and OTC medications, physiologic changes related to aging, cognitive and sensory changes, drug-testing methodology, knowledge deficits, and financial concerns.
What should you instruct the independent living older person to do?
1. Take most medications with milk or antacids to avoid stomach upset.
2. Avoid drinking alcohol if taking acetaminophen (Tylenol).
3. Keep daily medications in the kitchen cabinet near the sink.
4. Save prescription drugs in case the care provider orders them again.
Correct answer: 2
Excessive use of acetaminophen (Tylenol) can damage the kidneys, and if the patient uses alcohol heavily, it can also damage the liver.
You are caring for a new patient who had a heart transplant five years ago. She takes seven medications every day, including antirejection drugs, cardiac medications and inhalers. She mentions feeling “depressed,” and wants your advice about trying a new “natural” remedy she found on the internet. Which of the following would be the best response?
1. “That might be a good idea. I have heard good things about St. John’s Wort.”
2. “My Aunt Judy used to take some of those herbal remedies, and she died from liver failure.”
3. “You really should talk with your doctor first, because many things can interfere with your antirejection and heart medications, even herbs and supplements.”
4. “You’re on too many pills already; you should start an exercise program instead and fresh air to help you feel better.”
Correct answer: 3
Herbs and nutritional supplements, as well as OTC medications, all have the potential to interact with prescription medications a patient takes and actually contribute to the problem of polypharmacy. Some may cause liver failure, many interact with cardiac medications, and some decrease the effectiveness of anti-rejection medications. Although some may be potentially useful, a conversation with the prescribing physician is important to have so that effects can be monitored and dangerous drug-herb interactions can be avoided.
Under what circumstances is the nursing supervisor of an extended care facility most likely to refer to the STOPP Criteria?
1. Medication aide administers the medication to the wrong resident
2. Older resident is unable to swallow the prescribed medication
3. NSAID is ordered for a resident with severe heart failure
4. Staff nurse requests chemical restraints to control a resident
Answer 3: The STOPP Criteria gives example of drugs that may be inappropriate for older adults under certain circumstances. An order for NSAIDS for a patient with moderate to severe heart failure should be questioned; therefore, the nursing supervisor would contact the provider who ordered this medication (See Table 7-3 for additional information.) The medication aide needs counseling about proper use of patient identifiers. If the patient is unable to swallow, the nurse would use nursing process to assess for reasons and then plan interventions accordingly. Use of chemical restraints for control violates patients’ rights, thus the nursing supervisor would remind the staff nurse about the Omnibus Budget Reconciliation Act (OBRA) of 1987.
The nurse is caring for an older patient who is receiving gentamicin.
Which patient factors create a concern for an excessive blood level of this medication?
1. Dehydrated with difficulty swallowing
2. Overweight with excessive fatty tissue
3. Urinary retention secondary to enlarged prostate
4. Age-related changes in the gastrointestinal system
Answer 1: Gentamicin is a water-soluble drug; therefore, dehydration results in excessive concentration of the drug. Fatty tissue is a concern when drugs are fat-soluble. Kidney function is necessary for excretion; however urinary retention is not related to serum drug levels unless the retention damages the kidneys. Gentamicin is generally given intravenously, so the gastrointestinal system is not involved.
During a home health visit, the nurse observes the older patient and her daughter arguing about the patient’s judgment in self-administering medication. What should the nurse do first?
1. Ask the daughter to describe her concerns
2. Ask the patient to describe how she takes her medications
3. Gently suggest that the daughter take over the medications
4. Advise use of a pill box sectioned into days of the week
Answer 2: The nurse would first ask the older patient to describe how she is taking the medications. This shows respect towards the older patient and the answer will give insight to deficits in knowledge or errors in judgment. The nurse may then decide to use the other options.
The nurse has been administering medication to the older patient for several days, but today one of the pills has a different shape and the nurse does not recognize the name on the label. What should the nurse do first?
1. Call the pharmacy and ask if they delivered the correct medications
2. Call the health care provider to see if orders were recently changed
3. Use a drug reference to verify the identity and purpose of the medication
4. Give the medication because the pharmacist has checked the order
Answer 3: The nurse would use a drug reference to verify the identity and purpose of the drug. If there is still a question, the nurse would check the orders and then call the pharmacist if the delivered medication does not match the orders. The health care provider is consulted for additional clarification as needed. The nurse would never give an unfamiliar medication before the correct drug is verified.
The home health nurse discovers that the older patient has been taking a medication every day, but the label says, “Take every other day.” What would the nurse do first?
1. Call the prescriber and report the over dosage
2. Call Poison Control or the pharmacy and ask for advice
3. Assess the patient for adverse or toxic effects
4. Write the label instructions in large block letters
Answer 3: The nurse would first assess the patient for symptoms of distress and adverse effects of toxicity and take vital signs. The nurse would conduct additional assessment about how long the patient has been taking the excessive dose and effects before notifying the prescriber. Before calling Poison Control, the nurse would obtain additional information, such as weight, age, dose and frequency of ingestion, and first-aid. When the patient is safe and the immediate issue is addressed, the nurse needs to conduct additional assessment to identify other problems related to medication and plan interventions accordingly.
A float nurse is administering a large enteric-coated tablet to an older patient who cannot swallow very well. The patient tells the nurse, “The other nurses always crush this for me.” What should the float nurse do?
1. Crush the tablet, because the patient prefers this method
2. Convince the patient that swallowing the pill is possible
3. Document that the patient refuses to swallow the pill
4. Notify the charge nurse about what the patient said
Answer 4: The float nurse should alert the charge nurse about what the patient said, because this statement needs follow-up. The nurse would conduct additional assessment of the swallowing and based on this assessment the nurse might try to convince the patient to swallow the pill, or the nurse may decide that the provider should be notified to change the medication or form. Because the nurse is a floater, the charge nurse should be involved in the decision-making process and corrective actions.
The older patient is prescribed a diuretic mediation to help control hypertension. What does the nurse suggest during the medication teaching?
1. Take the medication after the evening meal
2. Take the medication early in the day
3. Take the medication whenever it is convenient
4. Take the medication with milk
Answer 2: If diuretics are taken early in the day, this lessens frequency of trips to the bathroom at night.
An older patient has recently been admitted to the hospital. On the third day, the patient agrees to take his routine medication but refuses to take medications that have been prescribed for the admitting medical diagnosis. What should the nurse do first?
1. Document the patient’s refusal of the specific medications
2. Ask the patient to explain reasons for refusing the new medications
3. Ask the patient’s significant other to encourage adherence
4. Inform the charge nurse and the health care provider
Answer 2: The nurse would first try to determine why the patient is refusing the newly prescribed medications. If the reason can be established, the nurse can design interventions for the specific cause. For example, the patient may not understand the purpose of the medications or may be having side effects. Based on the assessment, the nurse might also use the other options.
What signs/symptoms would the nurse assess for which indicate that the patient may be experiencing toxicity or adverse effects related to prescribed digoxin?
1. Visual spots
2. Difficulty urinating
3. Dark tarry stools
4. Feeling cold
Answer 1: For patients who take digoxin, the nurse would assess for visual spots, dizziness, headaches, fatigue, drowsiness, mental changes, numbness around lips or of hands, altered pulse rate or regularity, loss of appetite, nausea, vomiting, diarrhea, or weight loss.
With aging, which medication increases the risk for gastrointestinal problems, such as nausea, vomiting, and occult blood loss?
1. Theophylline
2. Ranitidine
3. Haloperidol
4. Naproxen
Answer 4: Nonsteroidal anti-inflammatory agents, such as aspirin, ibuprofen, tolmetin, and naproxen increase the risk for gastrointestinal problems.
Which assessment tool is most highly regarded, and often used to determine the mental status of the older adult?
1. SPICES Assessment Tool
2. The Mini-Cog™
3. Short Test for dementia
4. MDS 3.0
Correct answer: 2
Many assessment tools are available to assist nurses in assessing mental status in older adults. Although others are also well known, the easiest and most highly regarded is the Mini-Cog™
When assessing the respiratory system of an older adult, the nurse hears continuous, coarse, low-pitched sounds. How would these be reported?
1. Rales (crackles)
2. Wheezes
3. Friction rub
4. Rhonchi (gurgles)
Correct answer: 4
Gurgles (rhonchi) are adventitious lung sounds characterized by continuous low-pitched sounds with a coarse snoring quality. They are cleared by coughing and are heard over the trachea and bronchi.
When taking a radial pulse of an older adult, the nurse finds it difficult to count a weak and thready pulse. What should the nurse do?
1. Gently apply more pressure with three fingers to obtain a stronger pulse.
2. Take the person’s blood pressure to get the heart rate reading from the machine.
3. Take an apical pulse instead.
4. Record, “Weak, thread pulse, rate N/A.”
Correct answer: 3
Weak, thready pulses are often seen in individuals with fluid volume deficits or electrolyte imbalances; full or bounding pulses may indicate excessive fluid volume. Weakness of a radial pulse may make palpation impossible and necessitate use of the apical route.
When performing an assessment of the gastrointestinal system of an older adult, the nurse would proceed in what order? Place the parts of a gastrointestinal system assessment in sequence from first to last.
1. Palpate abdomen.
2. Observe abdomen for scars.
3. Obtain a health history.
4. Inspect the oral cavity.
5. Auscultate bowel sounds.
Correct order: 3, 4, 2, 5, 1
Before starting a physical assessment, the nurse will use interviewing techniques to obtain a health history. Once the history is obtained, the nurse is then ready to proceed to the physical assessment.
Complete physical assessment should be done in an orderly manner so that no important observations are missed. Assessment should begin with an overview of the person and proceed with more focused assessments. The most common method of physical assessment is a head-to-toe
approach in which the entire body is assessed systematically. An assessment of the gastrointestinal system of an older adult would begin with the health history and then proceed from head to toe, starting with inspection and progressing to auscultation and lastly palpation.
When performing an interview with an older adult, the nurse should consider physical environment factors by: (Select all that apply.)
1. Explaining what will take place during the assessment
2. Ensuring privacy and minimum noise levels
3. Selecting a room with a comfortable temperature
4. Ensuring bright lighting to enable the older adult to see clearly
5. Having the interview done by a nurse of the same gender to build rapport
6. Seeking a location in close proximity to a restroom
Correct answers: 1, 2, 3, 6
When performing a patient interview, attention to making the older adult comfortable is important, including providing an environment that is properly illuminated, but not too brightly, as glare can be harsh on the older eyes.
Temperature should be comfortable, and it is important to provide for physical needs (e.g., offering the bathroom before beginning) and privacy. One should begin the interview by explaining what to expect. Providing a nurse of the same gender is generally not required but should be accommodated if requested by the patient.
When performing an interview with an older adult, the nurse should consider physical environment factors by: (Select all that apply.)
1. Explaining what will take place during the assessment
2. Ensuring privacy and minimum noise levels
3. Selecting a room with a comfortable temperature
4. Ensuring bright lighting to enable the older adult to see clearly
5. Having the interview done by a nurse of the same gender to build rapport
6. Seeking a location in close proximity to a restroom
Correct answers: 1, 2, 3, 6
When performing a patient interview, attention to making the older adult comfortable is important, including providing an environment that is properly illuminated, but not too brightly, as glare can be harsh on the older eyes.
Temperature should be comfortable, and it is important to provide for physical needs (e.g., offering the bathroom before beginning) and privacy. One should begin the interview by explaining what to expect. Providing a nurse of the same gender is generally not required but should be accommodated if requested by the patient.
During a community health fair a nursing student obtains a blood pressure (BP) reading of 180/106 mm Hg on an older person who has not had his BP evaluated for several years. The older person reports “just having a cup of coffee to relieve a mild headache.” What should the student do first?
1. Have the person rest, repeat the BP, and notify the nursing instructor
2. Have the person lie down, call 911, repeat the vital signs, and assess for other symptoms
3. Repeat the BP on the opposite arm and assist the person to call his health care provider
4. Give a copy of the BP results to the person and advise him to see his health care provider
Answer 1: The nursing student should make the patient comfortable, repeat the BP to verify results, and consult with the nursing instructor for further advice. The person is having a “mild headache,” which should be further assessed. In addition, the patient’s baseline BP is unknown and health history is unknown, so additional assessment should be performed, but this is beyond the capabilities of the student. Based on the assessment findings, the nursing instructor will decide how to advise the older person.
The nurse is interviewing an older patient. The patient’s daughter is present and continually corrects her mother’s responses or answers for her mother. What should the nurse do first?
1. Assume that the daughter is the spokesperson for her mother and is better able to answer questions
2. Let the daughter speak freely but maintain direct eye contact and attention toward the patient
3. Direct the questions toward the patient and tactfully ask the daughter to allow the patient to speak
4. Politely ask the daughter to leave and then speak to the daughter afterwards for verification of patient information
Answer 3: The first strategy would be to try to elicit information directly from the older patient. The nurse would be continually assessing the verbal and nonverbal behaviors of the
older patient and the daughter and possibly may decide to try the other options as needed.
The nurse is interviewing an older patient. The patient’s daughter is present and continually corrects her mother’s responses or answers for her mother. What should the nurse do first?
1. Assume that the daughter is the spokesperson for her mother and is better able to answer questions
2. Let the daughter speak freely but maintain direct eye contact and attention toward the patient
3. Direct the questions toward the patient and tactfully ask the daughter to allow the patient to speak
4. Politely ask the daughter to leave and then speak to the daughter afterwards for verification of patient information
Answer 3: The first strategy would be to try to elicit information directly from the older patient. The nurse would be continually assessing the verbal and nonverbal behaviors of the
older patient and the daughter and possibly may decide to try the other options as needed.
The unlicensed assistive personnel (UAP) reports to the nurse that a thin older patient’s BP is lower than expected. The nurse immediately assesses the patient and repeats the BP. The patient is asymptomatic and the BP is at the patient’s baseline.
Which question is the nurse likely to ask the UAP about the low BP value?
1. “Did the patient seem upset or agitated when you took the BP?”
2. “What size of cuff did you use on the patient’s arm?”
3. “Was the patient lying flat in bed during the procedure?”
4. “Did you palpate the patient’s brachial artery first?”
Answer 2: In a thin older patient, the most likely error is using a cuff that is too large. This will produce an artificially low reading. Emotional distress is more likely to temporarily increase BP. Lying flat in bed should not cause a low BP.
(If the patient is asleep, the BP could be lower.) Locating the brachial artery before applying the cuff is a correct step that is often omitted, but failure to locate the brachial artery would not alter the BP unless the UAP repeated the procedure over and over again without allowing the blood flow to recover.
A 62-year-old woman, with no known health problems, comes to the clinic for her annual health and wellness examination. Which screening examination is most likely to be performed during this annual visit?
1. Cholesterol levels
2. Hearing screening test
3. Blood Pressure
4. Type 2 diabetes screening
Answer 3 Blood pressure measurement is recommended annually after the age of 40. Cholesterol testing is performed every 5 years. Hearing screening is done every 10 years and diabetes testing is done every 3 years for those with risk factors.
Which symptom in an older adult would alert the nurse to possible thyroid disease?
1. Vague respiratory symptoms
2. Fatigue and reports of “slowing down”
3. Mild abdominal discomfort
4. Low-grade fever
Answer 2: Hypothyroidism can be mistaken as normal aging with feelings of fatigue and a slowing down of body systems. Fatigue and slowing are typically associated with hypothyroidism. In older adults, atypical manifestations of fatigue and “slowing down” could also be seen in hyperthyroidism. In hyperthyroidism, the patient is more likely to be agitated and body systems would be over active. Vague respiratory symptoms and mild abdominal discomfort could signal a “silent” acute abdomen.
Low-grade fever or no increase in temperature could accompany serious infections in older adults.
Which sign/symptom is a cause for the greatest concern?
1. Loss of sensation in a swollen leg
2. Emesis with frank blood
3. Rigid abdomen with absent bowel sounds
4. Chest pain with a pulse of 38/min
Answer 4: All of these signs/symptoms are serious and warrant notifying the health care provider; however, chest pain with severe bradycardia is a 911 call in the home setting or requires activation of the rapid response team in acute care inpatient settings.
The nurse is preparing to assess the blood pressure of a patient and measures the patients arm to determine the proper sized cuff. The diameter of the patient s arm is 50 cm.
How wide should the blood pressure cuff be?
60
Older adults developing various disease processes may present with different symptoms from younger adults. The nurse would be concerned about which disease if the patient were to demonstrate a decreased appetite, constipation, and changes to his sleep pattern in which he is awake at night and sleeps during the day?
Depression
An older client reports to a nurse, “My daughter says there is something wrong with my hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around, I had some trouble. I think it is that my granddaughters mumbles a lot, just like all young people. I guess it has been getting steadily worse; it seems to be both ears as well.” Based on the client’s description, the nurse suspects which of the following?
Presbycusis
An older nursing home resident reports that her hearing loss is getting worse. What is the first action of the nurse?
Examine the resident’s ears for cerumen impaction
An older patient asks a nurse, “My doctor referred me to a hearing specialist who thinks that surgery for a cochlear implant may be beneficial for me. Can you tell me how one of those things works?” The nurse formulates a response based on the knowledge that:
A cochlear implant directly stimulates the auditory nerve
A 74-year-old client who has experienced a progressive loss of hearing acuity in recent years obtains a new hearing aid. Which of the following should be included in the nurse’s teaching plan?
“Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise.”
A nurse in an assisted living community notes that one of the residents who has hearing impairment and new bilateral hearing aids frequently does not wear the hearing aids. The nurse knows that which of the following factors contribute to low hearing aid use after purchase? (SATA)
A: Difficulty placing hearing aid properly in the ear
B: Stigma associated with wearing a hearing aid
C: Difficulty changing the batteries in the hearing aid
D: Ineffectiveness of hearing aids for individuals with age-related hearing loss
E: Hearing annoying loud noises
A: Difficulty placing hearing aid properly in the ear
B: Stigma associated with wearing a hearing aid
C: Difficulty changing the batteries in the hearing aid
E: Hearing annoying loud noises
An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of sensorineural hearing loss include: (SATA)
A: Tumors of the middle ear
B: Cerumen impaction
C: Infections of the external and middle ear
D: Age-related hearing impairment
E: Excessive and loud noises
D: Age-related hearing impairment
E: Excessive and loud noises
The nurse is most concerned by observing when assisting with an older client’s bath:
A slightly raised multicolor lesion with an asymmetrical, irregular border
An older person is admitted to the hospital with an exacerbation of congestive heart failure. The nurse notes that the patient complains of severe itching at night and has a red rash on her torso. The patient is diagnosed with scabies. The patient asks the nurse, “How did I get something like this?” The best response by the nurse is:
“Scabies is highly contagious and spreads easily though physical contact”
A nurse is providing an educational session on vaccines to a group of older adults. The nurse is discussing the zoster vaccine (Zostavax). Which of the following information should the nurse include in the education?
Zostavax is recommended for all individuals over age 60 that have no contraindications to the vaccine
A nurse is assessing an older patient and notes a cluster of fluid-filled vesicles on the right thoracic area. The nurse suspects HZ. The patient asks the nurse, “I really don’t understand how I got shingles. I don’t even know anyone who has this infection.” The nurse includes which of the following in formulating a response to the patient?
HZ is caused by a reactivation of dormant varicella zoster virus within the sensory neuron of the dorsal root ganglion
A nurse assesses a nursing home resident’s pressure injury to be a “healing stage III” The primary reason reverse staging is never used because:
Not all tissue layers are replaced as a wound heals, and the healed skin is not as strong as it originally was
A nurse is caring for an older adult with xerosis. Which of the following interventions should the nurse include in the patient’s plan of care? (SATA)
A: Encourage adequate fluid intake
B: Encourage daily baths of at least 20 minutes
C: Maintain a humid environment
D: Apply water-lade emulsions to skin immediately after bathing
E: Use only deodorant soaps when bathing
A: Encourage adequate fluid intake
C: Maintain a humid environment
D: Apply water-laden emulsions to skin immediately after bathing
A nurse is caring for an older adult with xerosis. Which of the following interventions should the nurse include in the patient’s plan of care? (SATA)
A: Encourage adequate fluid intake
B: Encourage daily baths of at least 20 minutes
C: Maintain a humid environment
D: Apply water-lade emulsions to skin immediately after bathing
E: Use only deodorant soaps when bathing
A: Encourage adequate fluid intake
C: Maintain a humid environment
D: Apply water-laden emulsions to skin immediately after bathing
AN older patient complains of pruritus. The nurse suggests which of the following interventions to alleviate the patient’s complaint? (SATA)
A: Use only non perfumed laundry detergent and fabric softeners
B: Avoid sudden temperature changes
C: Wear loose-fitting clothing
D: Apply heat to affected areas
E: Exercise vigorously for at least 30 minutes daily
A: Use only non perfumed laundry detergent and fabric softeners
B: Avoid sudden temperature changes
C: Wear loose-fitting clothing
An older patient tells a nurse. “The nurse practitioner told me that these ugly purple bruises on my arms are called purpura and are due to fragile blood vessels. I still don’t understand why this happens to me.” The nurse responds based on the knowledge that:
(SATA)
A: Purpura is due to normal age-related changes
B: The incidence of purpura increases with age
C: Purpura is precancerous skin condition
D: Individuals who take blood thinners are especially prone to purpura
E: Individuals prone to purpura should make sure that affected areas are open to the air
A: Purpura is due to normal age-related changes
B: The incidence os purpura increases with age
D: Individuals who take blood thinners are especially prone
An older patient tells a nurse. “The nurse practitioner told me that these ugly purple bruises on my arms are called purpura and are due to fragile blood vessels. I still don’t understand why this happens to me.” The nurse responds based on the knowledge that:
(SATA)
A: Purpura is due to normal age-related changes
B: The incidence of purpura increases with age
C: Purpura is precancerous skin condition
D: Individuals who take blood thinners are especially prone to purpura
E: Individuals prone to purpura should make sure that affected areas are open to the air
A: Purpura is due to normal age-related changes
B: The incidence os purpura increases with age
D: Individuals who take blood thinners are especially prone
A nurse is educating a group of nursing assistants in LTC on the prevention of skin tears. Which of the following interventions should the nurse include in the education? (SATA)
A: Lubricate the resident’s skin with moisturizers twice daily
B: Ensure that the resident has adequate nutrition and hydration
C: Bathe the resident in hot soapy water
D: Avoid the use of lifting sheets when transferring the resident
E: Dress the resident in long sleeves and long pants to protect the extremities
A: Lubricate the resident’s skin with moisturizers twice daily
B: Ensure that the resident has adequate nutrition and hydration
E: Dress the resident in long sleeves and long pants to protect the extremities
Which of the following are sub scales on the Braden Scale for predicting pressure ulcers? (SATA)
A: Nutrition
B: Moisture
C: Mobility
D: Age
E: BMI
A: Nutrition
B: Moisture
C: Mobility
An older adult who is within a normal weight range asks a nurse, “ I have heard that it is important to limit the amount of fats in my diet, but I don’t know how much I should be taking in daily. Can you help me?” The best response by the nurse is:
“Less than 10% of calories per day should come from saturated fats”
A nursing student asks the instructor, “Our textbook discussed the obesity paradox in older adults. I am not sure I understand; isn’t obesity bad for everyone?” The best response by the
instructor is:
“While there is evidence that obesity in younger people lessens life expectancy, overweight and obese adults do not have the same risk of morbidity and mortality”
A nurse identifies that an older adult needs more education on nutritional needs when the older adult states the following:
“Since I am an older person, I need more calories because my metabolic rate is slower”
An older adult asks a nurse, “I hear a lot about getting enough fruits and vegetables in my diet and eating a balanced diet. It is confusing. Can you help me understand what a balanced diet for me would be?” The nurse bases a response on which of the following?
Daily intake should consist of 50% fruits and vegetables; 25% grains; and 25% protein-rich foods
A hospitalized older adult who recently had surgery and a wound infection postoperatively is noted to be losing weight despite consuming his meal trays and snacks. One reason that this might be occurring is:
An injury may trigger inflammatory mediators that increase metabolic rate and impair nutrient utilization
An older adult’s nutritional status is screened by a nurse using the Mini Nutritional Assessment (MNA). The older adult scores a “7” (risk for malnutrition) on the screening portion of the tool.
The best action by the nurse is to:
Perform a comprehensive nutritional assessment
A nurse is preparing to hand feed an older adult with a history of a right cerebrovascular accident (CVA) with facial weakness and dysphagia. Which techniques should the nurse utilize when feeding this patient? (SATA)
A: Sit the patient upright in a chair at 90 degrees
B: Allow the patient to sit upright for 15 minutes after the meal is completed
C: Feed the patient only liquids to make swallowing easier
D: Place the solid food in the left side of the mouth
E: Have the patient swallow twice for every mouthful of food given
A: Sit the patient upright in a chair at 90 degrees
E: Have the patient swallow twice for every mouthful of food given
Many older adults have a vitamin B12 deficiency. Reasons for this include which of the following?
(SATA)
A: Normal age-related changes in the stomach include a lower production of gastric acid making vitamin B12 absorption less efficient
B: The major source of vitamin B12 is sunlight, and older adults are less likely to be outdoors and absorb vitamin B12 in this manner
C: Proton pump inhibitors, a frequently prescribed medication in older adults, impairs absorption of vitamin B12 from food
D: Most older adults do not consume five servings of fruits and vegetables daily, which is the main dietary source of vitamin B12
E: Vegetarian diets increase the risk of vitamin B12 deficiency
A: Normal age-related changes in the stomach include a lower production of gastric acid making vitamin B12
absorption less efficient
C: Proton pump inhibitors, a frequently prescribed medication in older adults, impairs absorption of vitamin B12 from food
E: Vegetarian diets increase the risk of vitamin B12 deficiency.:
Symptoms of gastroesophageal reflex disease (GERD) in older adults include: (SATA)
A: Heartburn
B: Regurgitation
C: Abdominal pain within 1 hour of eating
D: Vomiting
E: Fever and elevated WBC count
A: Heartburn
B: Regurgitation
C: Abdominal pain within 1 hour of eating
A nurse is developing a care plan for an older adult in a LTC facility that has a nutritional problem. Which of the following interventions are appropriate to ensure adequate nutrition? (SATA)
A: Assign a nursing aide to feed the resident to ensure adequate consumption of meals
B: Supervise the resident during meals
C: Provide a pleasant eating environment
D: Provide nutritional supplements for the resident
E: Assess the resident for ability to feed him or herself
B: Supervise the resident during meals
C: Provide a pleasant eating environment
D: Provide nutritional supplements for the resident
E: Assess the resident for ability to feed him or herself
An older woman asks a nurse, “You always seem to be telling me that I need to take in more fluids. How much fluid do really need to drink?” The nurse bases her response on the knowledge that older adults should consume at least:
1500 mL of fluid per day
A nurse administers hypodermoclysis (HDC) to an older nursing home resident. The purpose of hypodermoclysis is:
To rehydrate an individual with mild to moderate dehydration
